Bill seeks to address gap in services for veterans

Legislation introduced in Maine aims to help the state bridge a gap for mental health services for military veterans.

“An Act Regarding Mental Health Care for Maine Veterans,” currently in the Veterans and Legal Affairs Committee, directs the Director of the Bureau of Maine Veterans’ Services within the Department of Defense, Veterans and Emergency Management to station at each of the bureau’s field offices a social worker to provide direct mental health care to veterans, to coordinate mental health care for veterans and to work with the federal government and state and local mental health service providers to provide mental health care to veterans.

It also requires the director to administer a grant program to providers of mental health services to veterans and appropriates $1,000,000 annually for the program.

The legislation is sponsored by Rep. Jared Golden, (D-Lewiston) a Marine Corps Infantry veteran who served in Afghanistan and Iraq, who said he has seen many of those he served with struggle with the transition home.

“I was diagnosed with posttraumatic stress myself,” Golden said.

Golden said he was diagnosed through VA (U.S. Department of Veterans Affairs) services but found the outreach services and follow-up lacking. “So for me, I just kind of learned through experience,” Golden said. “I ended up accessing care when I needed it in the community rather than through the VA.”

Once in the Legislature, Golden chaired a commission to look into services for veterans in Maine and learned that less than half of Maine veterans were enrolled in the VA health care system.

Golden hopes this legislation can help veterans who aren’t enrolled in the VA system have greater access to mental health care services and help even those who do receive services through the VA avoid wait times to receive services.

Adria O. Horn, director, Maine Bureau of Veterans’ Services, said that she does not support the legislation as written.

“My litmus anytime I read new legislation is, ‘How can I implement something so that it’s not a burden to the veteran?’” said Horn, herself a veteran of the Army.

In this case, Horn said, there are too many questions regarding the implementation of the legislation, as the bureau’s eight field offices are not set up to house a social worker to provide direct mental health care.

“I don’t have any office space for a mental health provider to come in and be able to perform the way they expect to be able to perform clinical services,” Horn said, citing patient confidentiality and privacy issues, among other concerns. “Environment is important.”

From a staffing perspective, the bureau would also need to add another senior position to oversee the mental health workers and there is no one currently employed in a senior position with clinical oversight and management experience who could also then serve as a clinical director of mental health services, she said.

She noted that the bureau has never provided a direct clinical service like mental health before and would need to create established procedures and protocols.

Horn said as drafted, the legislation changes the mission of the bureau without inviting conversation and change on a much broader scale. But she said she believes that the right solution can be found. “I think we are really on the right track on this,” she said. “So if we really want to address this, and I know that’s what the intent is, then let’s do it right.”

Horn said the VA provides mental health care throughout Maine and she believes a lot of veterans are happy with that care. “But a lot of those people probably would benefit from some type of case management, and there is a dearth of case management throughout the entire VA system,” Horn said.

“From a state level, I think the state makes itself an indispensable partner when it fills a gap that the federal government isn’t doing or the community is unable to provide – complementary services, not duplicate of services,” Horn said. “And personally, what I have seen is that the VA does really provide good mental health care for those who are using the mental health care system.”

Horn said case management is an example of filling an existing gap, and a case management program could help veterans navigate state and federal agencies to receive care.

Golden said that while it is his preference that the bureaus hire social workers, that aspect of the bill is intended to address the dearth of case management.

“I view those positions as case managers to work with veterans, as we’ve identified a need for that special care to connect them with resources,” Golden said.

The legislation wasn’t intended to get the bureau in the game of providing direct care, Golden said, “but rather, to bring in the resources to those who are already doing that and filling what everyone sees as a gap in our state and I suspect in most states – in case management.”